Disability Insurance

There exists many types of benefits for disabled persons, including those provided through Social Security, workers compensation, and other state and federal programs.

At the Law Offices of Jeffrey C. Metzger, however, we handle claims under private disability income insurance. Disability insurance provides a monthly sum of money to employees and policyholders who are unable, due to sickness or injury, to perform material and substantial duties of their own occupation, or any occupation for which they are reasonably qualified by education, training or experience.

If you have disability insurance with Unum, Prudential, Met Life, Cigna, Hartford, Aetna, Guardian, Massachusetts Mutual, Principal Life, Lincoln National, Reliance Standard, or any other disability insurance company, are disabled and entitled to benefits, and are being unfairly treated by your insurance company, please contact us for a free consultation.

Types of Disability Insurance

Individual Disability Insurance

As the name suggests, individual disability insurance is sold directly to the individual, i.e., as opposed to group insurance through one’s employment. The types of individual disability insurance may be disability income insurance, which provides a monthly income benefit in the event of the policyholder’s disability from generally his or her own occupation. Another type of disability insurance is business overhead insurance, which provides reimbursement for the policyholder’s ongoing business expenses in the event of a disability. A third type of individual disability insurance is credit disability insurance, in which the insurance company agrees to make the policyholder’s mortgage or car payments in the event of a disability.

Most individual disability policies provide benefits in the event of the insured’s inability to perform at his or her own occupation for the entire life of the contract. Many of these contracts are non-cancellable/guaranteed renewable, meaning that if the insured develops a non-disabling medical condition that the insurance company believe may someday become disabling, it may not prevent the insured from renewing the contract at the end of the term.

Unfair or unreasonable denials of claims under these policies subject the insurance company not only to liability for the amount of the unpaid benefits and interest, but also for bad faith damages, i.e., damages caused to the policyholder as a consequence of the claim being denied. Such damages may consist of emotional distress, loss of economic opportunities, damage to credit, attorneys’ fees and punitive damages.

Such bad faith conduct may consist of:

• Denying your claim or terminating your benefits on the asserted ground that you are not disabled by refusing to properly credit the opinion of your doctor, and/or basing the decision of a doctor hired by the insurance company.

• Denying your claim or terminating your benefits (or threatening to do so) on the basis of surreptitious surveillance that shows you doing some activity unrelated to your work.

• Burying you in unnecessary and voluminous paperwork, and terminating your benefits (or threatening to do so) when you are unable to complete it to the insurer’s satisfaction.

• Retroactively cancelling your policy (rescission) by claiming that you misrepresented facts on your application for insurance about your health or employment history.

Long-Term or Short-Term Disability Insurance

The other main type of disability insurance is long-term or short-term disability that is offered to employees as a benefit through their employment. The employee is generally entitled to this insurance merely by being an employee; i.e., there is no underwriting that must be satisfied before the insured is covered. However, because the insurance company is taking on every risk, as compared to individual disability insurance, the benefits are limited in certain significant ways.

• First, the insured is covered for the inability to perform his or her own occupation only for the first two years of disability. Thereafter, he or she must be unable to perform at any occupation for which he or she is reasonably trained, educated, or experienced in order to collect benefits, a more stringent or difficult burden of proof.

• Second, the policies may limit benefits to two-years for certain kinds of medical conditions, such as mental and nervous conditions, or physical disabilities based on chronic pain.

• Third, the amount of the benefit (usually a percentage of one’s income, e.g. 60%) is offset, or reduced, by other sources of income, including Social Security, State Disability, and/or Workers Compensation Benefits.

• Fourth, most claims under these policies are governed by ERISA, requiring an administrative appeals process, and limiting the amount of the recovery even if successful in court.

If your long-term or short-term disability claim is denied, we urge you to seek representation immediately! We urge you not to attempt to submit your own appeal to the insurance company, as there are many pitfalls in that process that may prevent you from reversing the decision to deny your benefits. In such a situation, please contact our office for a free consultation. Talk to us!

Dealing with and against your Disability Insurance Company

Disability insurance companies are in the business to make a profit, and they are enormously successful in doing so. By refusing to pay claims, they keep their costs down, which increases profits. Thus, there is a built-in incentive to the companies not to pay claims. This is not to say that the companies deny every valid claim, but it is likely that you are reading our website because of a concern of how you have been or will be treated by an insurance company.

Successfully pursuing a denied disability insurance claim (or even a threatened denial) requires competent counsel against highly financed opposition. To maximize both your chances of recovery, and the amount of such recovery, it is in your best interest to turn to a highly experienced disability insurance lawyer.

We have the proven track record of obtaining successful recoveries for our clients. For over 25 years, we have been representing insurance policyholders against insurance companies, particularly disability insurance companies.